The Global Body Part Four: The future of the human race

In this the final in our Global Bodies series Lynne Malcolm and a panel of experts in population, health and environment explore what’s in store for us; our bodies, our lifestyles and our health in the next century. Ultimately will the human race even survive into the next millennium?

So-called lifestyle, or non-communicable diseases like heart disease, stroke, lung disease, cancer and diabetes will be the biggest challenges to the human body in the next century. These diseases will affect rich and poor alike, but where the rich can make educated choices about what to eat and understand the benefits of exercise; the poor cannot make the same lifestyle choices. We hear how in Manila in the Philippines poor communities who don't have the same access to clean water or electricity are suffering serious health problems. With demands on lowly paid workers to work longer, there's no time for exercise -- and the heat in Manila makes it all too hard.

Climate change will also be a factor in our health. Professor of population health Tony McMichael explains, 'It’s no surprise that bacteria, mosquitoes and ticks that spread some of these infectious diseases, they’ll do better in a warmer world, within limits... but by and large infectious diseases will tend to proliferate more rapidly and spread more widely.'

This program was first broadcast on 2 April, 2012.

The Global Body series

The Global Body part one: Rural developing world (Sri Lanka). In The Global Body series we explore how the human race has adapted to changes in their environment, economy and social structures; how health is affected by new environments and lifestyles; and what might happen to the human race in the future.

The Global Body part two: Developing world city - Manila. Billions of people have been migrating to the cities in the developing world, driven by political pressure, environmental vulnerability and employment opportunities. What happens to our human bodies when we leave the fields and shorelines and head into the big city?

The Global Body, Part 3: Developed World City - Los Angeles. Is the Hollywood dream of a city of beautiful, fit, wealthy people anything near the truth for this massive city? We explore how the inhabitants of LA have adapted biologically to their new environment over time, and what the impact is on their health and bodies.

In this the final in our Global Bodies series Lynne Malcolm and a panel of experts in population, health and environment explore what’s in store for us; our bodies, our lifestyles and our health in the next century and ultimately will the human race even survive into the next millennium.

Transcript

Lynne Malcolm: Hi I’m Lynne Malcolm with the Health Report’s final part in our Global Body series, an ABC-BBC co-production looking at the evolution of the human body in relation to the changes in today’s environment and lifestyles across the world. In this series we’ve heard from healthy Sri Lankan farmers who live off the land.

Lalitha Gunasekera: I believe that we live a very good life, because I don’t have to go to the market to by more stuff or food, so we have a very good life and a good diet as well.

Lynne Malcolm: And less healthy tea pluckers living high in the mountains.

Pushparani Chandralingam: We all often get influenza and diseases because of the cold and wet. All this because of the hard work, you know.

Lynne Malcolm: We’ve been to Manila in the Philippines to see how moving to the city affects our health.

Zorayda Leopando: If you are in the urban poor community sometimes you don’t have access to clean water. We might have some electricity. You wouldn’t have time to cook your own food, no time for exercise. Here in metro Manila people do not want to walk anymore because it’s so hot.

Antonio Dans: Heart disease, stroke, lung disease or cancer. We’re trying to debunk the theory that this is a disease of affluence. We think it’s a disease of the poor, because based on that theory, lifestyle is a choice, and the rich are able to fight that battle more easily than the poor. I can exercise; I can drive an hour away from Manila and put my bike on top of my car and bike where there’s no pollution. How’s a poor guy going to do that?

Lynne Malcolm: And we saw that people in the developed world, in Los Angeles, had their own issues.

Jonathan Fielding: We have the problems of sprawl. We have very high levels of air pollution. People spend too much time in cars. We have those factors that we know affect health and particularly overweight and obesity, lack of physical activity and the like.

Vickie Mays: There are places here where you can get a foot-long hotdog for $1.50 with all the trimmings. That will keep your stomach from growling for a long time.

Lynne Malcolm: Well, that’s a whirlwind tour of the state of the global body so far, but this week we’re going to be looking into the future and finding out what’s in store for us; our bodies, our lifestyles and our health in the next 100 years or so, and I’m joined by a panel of experts in population, health and environment.

Professor Maxine Whittaker of the Australian Centre for International and Tropical Health at the University of Queensland is on the line from Seoul in Korea. Tony McMichael, Professor of Population Health at the Australian National University in Canberra, and with me here in Sydney is Robyn Norton, Principal Director of the George Institute for Global Health, and also Professor of Public Health at the Medical School at the University of Sydney. Welcome to you all.

Well, as we’ve heard throughout The Global Body series, our environment has a massive impact on our bodies. I just thought in a sentence or two, could you highlight your biggest concerns about global health in the next 50 to 100 years or so? Can we start with you, Maxine Whittaker?

Maxine Whittaker: Yes, thank you very much, Lynne. My main concern is about the gap between the rich and the poor. The gap between the top 20 per cent of the income and the bottom 20 per cent of the income is increasing, so many of us are living longer and better and higher quality lives, but that bottom 20 per cent, the poorest of the poor, are often not having a chance to make those gains, and that’s one of my concerns, that inequity.

Lynne Malcolm: Okay. Tony McMichael?

Tony McMichael: Well, Lynne, I think Maxine, with good luck and management this century, may be right in terms of improving health broadly and reducing the gaps, but my main concern is really about the impacts of many of those truly global influences, in fact, and there are three things that I think distinguish today’s world in that respect. Firstly, the overcrowding, the population growth, secondly the overexploitation and depletion of limited natural resources. Perhaps most importantly and most unfamiliar to us, the overloading of many of the planet’s systems, such as the climate system upon which our health depends. I think that’s where the big risks will come from.

Lynne Malcolm: Okay, and Robyn Norton?

Robyn Norton: Thanks, Lynne. I think from the perspective of the George Institute, we see that the key challenge facing us in the future is how best to provide safe and effective healthcare and affordable healthcare for those who need it.

Lynne Malcolm: Well, we’ll start unpicking some of those issues during this program, but first, Robyn Norton, on our tour of The Global Body, one of the main themes that came up was the rise of chronic or non-communicable diseases. How big an issue is it?

Robyn Norton: It’s a huge issue. The latest figures that we have globally from 2008 show that already about two thirds of death worldwide were from non-communicable diseases. In countries like Australia and the UK and the US almost all deaths are associated with non-communicable diseases. What we’re going to see over the coming decades is that non-communicable diseases will become the leading cause of death also in middle income countries and increasingly also in low income countries. So for example, at the moment already in China about 80 per cent of deaths are from non-communicable diseases like heart disease and stroke.

Maxine Whittaker: Well, again, the poorest of the poor are often the ones having problems. Robyn’s right, I mean, a lot of it is linked to these changes in lifestyle, but we also know that structural and system level issues such as a lack of infrastructure for healthcare, urbanisation, poverty, lack of good government programs in poor countries are also drivers of this non-communicable disease epidemic, and that hampers proper prevention, surveillance and treatment. We need to mount that sort of a program to reduce the impact of NCDs, non-communicable diseases, on these poor countries, and the chance for people to be productive and live healthy quality lives.

Another interesting issue, and this was raised earlier in the series by one of your speakers, is finding out some of the changes happening to the human genome. We know that our genetic structure responds dynamically to the environment, and research is starting to show that stress, diet, behaviour, toxins, other factors actually may activate switches on our genes, and these genetic changes may then be inherited by the future generations. And we are seeing, with some research, that, for example, people who have been through famines in the past, so in poor countries, may actually have now genetic changes handed on to their children, which means that NCDs may occur earlier than we had seen with the lifestyle changes we have.

Lynne Malcolm: Interesting to see how that pans out. Robyn, these diseases are usually long- term and expensive to treat, but people do live with these diseases, and a lot of the world’s population is living longer, which is surely a good thing, so isn’t it a matter of statistics that these lifestyle diseases are going to be the ones that we eventually die of? After all, you have to die of something.

Robyn Norton: You do indeed, but, of course, living longer is a good thing. Particularly if we can identify, treat and manage health conditions of older people, and in managing them we can ensure that people live life to the full. However, we do know that for large proportions of the world, especially the poor, they do not have access to quality healthcare or can’t afford good healthcare, and so often times they won’t seek healthcare, and so conditions are poorly managed, leading to poorer health outcomes and arguably long term disability, and often it’s a time that leads people into greater levels of poverty. So, all around the world, in high income countries but especially in middle income countries, healthcare reform is on the agendas of most governments, including China. How best to ensure that we have sufficient healthcare workers who are trained, who can reliably identify, treat and manage individuals at risk of non-communicable diseases. How best to do that safely, effectively and affordably is a key issue.

Lynne Malcolm: Well, I’m going to bring Tony McMichael in here, because he’s been sitting quietly in our Canberra studio. Tony, are there any specific worries about climate change and these chronic lifestyle diseases?

Tony McMichael: Yes, they are important, Lynne, but I’ll make a perhaps slightly irreverent comment first up. It implies that really, we ought not to call these just lifestyle diseases, because that seems to point to the individual as the source of the problem, and you know this word’s been appropriated pretty widely by real estate agents and tour operators and so on about your lifestyle. Maxine was making the fundamental point that the problem that we face with the rise of NCDs, these non-communicable diseases, around the world is really the distortions, the shifts in ways of living for whole communities. These are changes in human ecology, and they put us out of kilter biologically, with the type of environment and pattern of living for which we’re best equipped. But the connections with climate change, I’ll just say briefly, at one level are the risks that the persons that are incubating heart disease, cardiovascular diseases, are overweight, have metabolic problems with diabetes. These persons are at considerably elevated risk in times of heat stress. Most of the deaths during severe heat waves, and we’re expecting to see more and more severe heat waves in a warmer world, most of the deaths are from persons with those underlying disease conditions. So that’s the very important connection. The other one is a sort of macro-connection that both climate change and the rise of non-communicable diseases are in so many respects manifestations of over-consumption, and it’s as simple as that. Consumer preferences and behaviours underlie many of the disease problems, the enormous ratcheting up of our economic activities, energy use and emission of greenhouse gases reflects overconsumption, so both of them draw attention to the need for us to reign in our behaviours.

Lynne Malcolm: And of course, Maxine, again it’s the poor who are less able to buffer themselves against these sorts of effects, isn’t it?

Maxine Whittaker: It is, I mean, as Tony was mentioning, heat stress is going to be a big problem for people who may be doing labouring as their main job. So if you’re working in India, in 40 degree temperatures, and you also have one of these chronic diseases, and probably another infectious disease on top of that, you’re not going to be able to be as productive. You’re not going to be able to bring even that daily wage home to look after your family, and you start this spiralling debt of ill health, needing to pay for care, the care often ending up being a catastrophic cost, because many countries cannot afford free healthcare for all of their citizens, or do not have insurance schemes, because people do not earn enough money to be able to pay for health insurance.

Lynne Malcolm: And Tony, what about infectious diseases in a warming world? In the developed world we can sometimes be accused of assuming that we have a handle on these already, but in the developing world diseases like malaria are still a major cause of death, and HIV/AIDS is still rising globally.

Tony McMichael: Yes, those things are true. In the ‘60s, the 1970s we thought, in a sense, we’d conquered infectious disease, as eminent scientists said, you know, it’s time to close the book on infectious disease. Well, the 1980s, ‘90s and on have taught us another lesson, that we’re actually living in a world where we’re doing all sorts of things as human populations that are destabilising the microbial world and creating opportunities for them to spread within human populations, and for many new types of infectious diseases to emerge.

But climate change is going to be increasingly an important influence on these diseases. It’s no surprise that bacteria, that mosquitoes and ticks that spread some of these infectious diseases, they’ll do better in a warmer world, within limits. They die if it gets too hot, of course, but by and large infectious diseases will tend to proliferate more rapidly and spread more widely. So, in the lower income countries, including many in our large Asia Pacific region, there are concerns and we’ve seen early evidence in the last couple of decades of the emergence of a number of virus diseases. The SARS, avian influenza strands, in Africa we’ve seen the emergence of diseases like Ebola and HIV-1 associated with the butchering of chimpanzee and gorilla meat. So, many of these things are increasing the rate at which we’re exposed. Climate is going to add another dimension of stimulus to many diseases in our region, and diseases like Japanese encephalitis and various other mosquito borne diseases are showing signs of spreading south and heading towards Australia as they move with the warmer world. In fact, the real problems associated with climate change in poorer populations are much more likely to be the sheer burden of disease, the increase in numbers of deaths from things like cholera and dysentery in a warmer world, in a world more prone to flooding, and the overloading of sanitation systems. That I think will be a major problem unless we can get seriously engaged in the eradication of poverty and the improvement of living conditions in these poorer parts of the world very quickly.

Lynne Malcolm: You’re listening to the Health Report on RN. I’m Lynne Malcolm with our ABC-BBC co-production series The Global Body. We’re focusing on what the future is going to look like for the human race. I’m with public health experts Professors Robyn Norton, Maxine Whittaker and Tony McMichael. Now, I know climate change is a huge topic, and its potential impact on human health could be discussed over many programs, but it’s not all bad news if we start to live in a more sustainable low-carbon way now. I spoke earlier to Professor Andy Haynes from the London School of Hygiene and Tropical Medicine in London, and he had this to say.

Andy Haynes: If we can move towards low-carbon or cleaner transport we get less air pollution, and particularly importantly, if we can encourage people to walk and cycle in cities, get them out of their cars, then we can actually reap very large benefits, because so much of disease in modern society is related to our sedentary lifestyle. Perhaps over 3 million deaths a year around the world from conditions like heart disease, diabetes, stroke, and there’s also recent evidence that it affects conditions like depression and increases the risk of dementia. So if we can get people actively travelling in cities for short distances, walking and cycling, that will help health in many ways, but also if we can move towards cleaner, more sustainable housing, using low-carbon energy sources, insulating houses more effectively and also putting in better ventilation control systems, we can improve exposure to indoor air pollutants as well as reducing the energy expenditure that we need to keep our houses warm.

Lynne Malcolm: Less reliance on our cars could be good news in areas of human health as well, couldn’t it, Robyn Norton? One of the areas you study is accidents. Give us an idea of the figures, the impact of traffic accidents around the world.

Robyn Norton: Not a lot of people appreciate the fact that already injuries globally kill more people every year than HIV/AIDS, malaria and tuberculosis combined. So let’s put injuries in a context which are often forgotten. Overall, there is about 5 million deaths every year from injuries, about one in every ten deaths in the world, and road traffic injuries are the leading cause of injury death, and individuals in low and middle income countries are disproportionately affected. I think increasing motorisation means that we’re likely to see more and more deaths from road traffic injuries in these countries, unless they do something about it right now. We know from high income countries like Australia, the UK, the US, that there are sufficient preventative strategies that can dramatically reduce road traffic injuries. So, yes, road traffic injuries are important, cars are an important component of that and there is much we can do to reduce the potential epidemics that may occur in low and middle income countries over the next few years.

Lynne Malcolm: And Maxine Whittaker, how significant do you see the accidents and injuries to be?

Maxine Whittaker: I agree wholeheartedly with what Robyn said. It is a major problem, and probably many of these injuries are also undercounted. I mean, we’re basing all of our discussions today on the figures that are available, but in many poor countries they have very poor health information systems. So many of these may be undercounted, particularly if they’re accidents that people know that they can’t afford to have the interventions at hospitals. We know also that children are particularly vulnerable, and there’s increasing interest on the issues of injury amongst children, drowning becoming a major problem, for example in Bangladesh, and also an under-addressed and definitely under-measured problem with injury is the intimate partner violence. What some people may call gender-based or partner violence. Again, often that is not counted, but we know particularly in times of stress, in times of living in refugee situations that intimate partner violence can actually often increase, and that’s definitely an under-counted problem of injury and a problem that’s worldwide and definitely under-addressed in many poor communities.

Lynne Malcolm: Maxine, we’re painting a fairly gloomy picture for the human body of the future, but one thing that’s supposed to be making our lives easier is technology, and by this I mean computers and communication. Are there ways that these sorts of technologies can improve access to healthcare?

Maxine Whittaker: Yes, Lynne. I mean, technology can be one of the things that helps us address these problems. A few examples I talk about; one is the use of mobile technology such as mobile phones for SMS texting. We often call this m-health, and what’s being done is transmission, rapid transmission of data in many settings. For example in Tanzania to identify outbreaks of disease so that there can be quick and prompter responses and try to nip it in the bud before it spreads into other communities, or again in Tanzania, there’s real-time monitoring of drug supplies against case load, particularly for malaria. At the moment they’ve piloted that so that where the drugs are needed the drugs can be moved quickly, and again you get effective healthcare and again increase the efficiency of that health system. I’m sure Tony would have further comments on this, I know they’re working in this area looking at the use of geographic data and using satellites and other remote sensing ways of layering geographic data with climate data, geography, mosquito habitats, people movement, vulnerable locations for disasters and so mapping all of those assists planning local solutions and making sure that countries that may not have a lot of money to provide healthcare can make choices about the most cost-effective interventions and therefore also improve the accessibility of those interventions to more people.

Lynne Malcolm: Tony McMichael, are there technological advances that could help mitigate climate change?

Tony McMichael: Well Lynne, I think the question highlights a pretty important distinction between cleverness and wisdom, because, you know, we rely very much, don’t we, on the hope that we put in technology, and I think we put too many eggs in that basket. We are clever, and we can always devise technologies to solve some specific problem, but we’ve got on our hand an unprecedentedly large and complex problem with global climate change and with all of the other large-scale global environmental changes that are the result of this first time ever series of pressures that humans are putting on the planet at large. Sure, we must try and move more and more to renewable energy sources and reduce our greenhouse gas emissions, and we may even be bold enough, I don’t think we should, but we may be bold enough to try the high-tech heroics of geo-engineering, but you know, every time we do things like this adverse unforseen results accrue and then we wish we hadn’t done it. So, yes, there are possibilities of that kind, but I think wisdom suggests that actually what this is about is taking stock of where we’re at, and the nature of the problems, their intergenerational dimension and saying, ‘We’ve really got to seek now a transformation of the way that we live around the world so that we can achieve true sustainability environmentally and equity socially and find a way into the future.’

Lynne Malcolm: Robyn, a couple of the useful technologies that you can see?

Robyn Norton: Firstly I’d just like to endorse what Maxine said. I think she’s stolen a lot of the thunder that I might have given to this discussion, because we certainly see that re-engineering old technologies if you like, and I use that term very broadly, as well as developing new technologies has to be part of the solution. But if I can move beyond devices, if you like, to looking at re-engineering drugs, one of the areas that we’ve spent quite a bit of time working is looking at how do you combine several drugs into one single poly-pill that’s cheap, effective and maximises adherence, because that’s a huge issue in many contexts. So I think that’s one example. Another approach, and one that I think we’ve had some coverage of recently, is the development of food apps, giving consumers choices to make healthy food purchases. So again, using new technologies that enable people to lead healthier lifestyles, but again, just coming back to Maxine’s comment earlier, I think the use of m-health technologies has to be part of the future strategy, particularly for rural populations and particularly for poor populations where we need to use those technologies in the absence of highly trained medical staff.

Lynne Malcolm: So, humans are living longer, and the birth rate is still growing in many parts of the world, and it’s all leading to a growing population, there’s the obvious question of, are we going to be able to sustain this? Tony, what are the knock-on effects on the climate, with increasing food production needed to feed the growing population?

Tony McMichael: Well, in a word they’re huge, because we’re talking about around 9 billion people by the middle of this century, and along with that a rapid rise in consumer expectation and preference in many of the countries that are becoming wealthier. In east Asia, for example, China, and where Maxine’s talking to us from in South Korea, where the consumption of red meat, for example, is escalating very quickly as more and more people prefer to have it in their diet, and I saw a statistic recently suggesting that at the moment China is importing about 40 per cent of Brazil’s soy in order to feed to the cattle; grow the meat quickly, high content of saturated fat, soft and easy to eat, meeting consumer preference, but you know, the agricultural sector counts for something of the order of about 30 per cent of the world’s total greenhouse gas emissions, and the livestock sector accounts for a good part of that, something of the order of 18 to 20 per cent. So, we’ve got to get very serious about the ways in which we produce food around the world and make that production much less environmentally intensive and much less a source of greenhouse gases, and that lies behind some of the discussion we’re beginning to see about the need to cut back on red meat from ruminant animals, these are the cattle, the sheep, the goats, the camels in some parts of the world and so on that have a very high production by regurgitation of methane, which is a very powerful greenhouse gas, much more powerful than carbon dioxide. So, these are big challenges for us and that’s why along with the concerns about some of the health risks from over consumption of higher saturated fat content animal foods we’re also seeing a move to transform methods of food production on behalf of the world’s climate and our healthy future at large.

Lynne Malcolm: Well, we’ve been on a whistle-stop tour of some of the future scenarios for the human race on the planet. Obviously we haven’t got time to go into every scenario, but I’d like to thank my guests today, Professors Tony McMichael, Robyn Norton and Maxine Whittaker. And lastly, just in the final minute, can I ask you to cast your minds even further into the future to see if you think people will even survive into the next millennium?

Maxine Whittaker: Well, thank you Lynne. Yes, I mean, many of us, us not personally, but, yes, I think the human race will survive, but as all of the speakers today have said, the decisions we make now as individuals, as communities, as societies and as global neighbours will impact on the quality of lives that we live and that our successors will live in the future, and the equity of global citizens to be able to have equal life expectancy and quality of life. As Tony mentioned already, some of the things we thought we’d got rid of in the past are re-emerging. Some of the clever things we did with antimicrobial agents, like antibiotics and antimalarials we’re now seeing microbes being resistant to those. There are threats coming to modern practice including the ones we’ve talked about today, like climate change and human population growth, so maintaining that balance in our own inner environment, our nearby environment and the global environment’s very important. Perhaps like Canada, we need to have in every country a health in all government policies approach, so that everything we do we think about the potential health impacts. That may put us in a better direction for the future.

Tony McMichael: Well, Lynne, I’m going to tackle it on a different scale and say that we’re reminded by ecologists that more than 99 per cent of the species that have ever lived on earth are now extinct. Among the family of dozens of apes that have lived over the last 15 million years, there are only four that remain today, and three of them are struggling to survive. The only one that for the moment is doing well, just in terms of sheer numbers, are the humans, but we’re overplaying our hand, and some of those big chickens are about to come back to roost, I think.

Robyn Norton: I’m totally optimistic. I think if you look at the best evidence we have over the last years, the health of the population has improved dramatically, so I’m hoping that that will continue.

Lynne Malcolm: Well that’s it for our Health Report series The Global Body on RN. The series is a co-production with the BBC World Service. The producer is Fiona Roberts and sound engineer Louis Mitchell. If you want to listen to the program again or download it later, or if you want to find out more about our guests and what they’ve been speaking about today, go to the Health Report webpage, abc.net.au/radionational/healthreport, and you can add your comments there too.

Norman Swan will be back next week with the Health Report. I’m Lynne Malcolm.

Guests

Professor Tony McMichael

Professor of Population Health,Australian National University,Canberra

Professor Maxine Whittaker

The Australian Centre for International and Tropical Health,University of Queensland

Professor Robyn Norton

Director of the George Institute,Professor of Public Health,University of Sydney,Professor of Global Health and James Martin Professiorial Fellow,University of Oxford, UK